Low FODMAP Diet Proven Effective, but is it Necessary?

Introduction

Digestive complaints affect nearly 100 million Americans. In most cases, the symptoms reflect disturbed digestive function or food intolerance rather than an underlying disease. Functional gastrointestinal disorders include occasional indigestion or heartburn, functional dyspepsia, excessive flatulence, and the irritable bowel syndrome (IBD). Relatively recently, a great deal of attention has finally started to look at certain foods that play a central role in digestive disturbances such as excessive gas, bloating, and changes in regularity. However, as discussed in the Commentary below, maybe the problem is not with the food, but rather how it is digested. Nonetheless, one of the most common culprits in causing digestive disturbances are FODMAPs – small carbohydrates in certain foods. FODMAP is an acronym for:

Fermentable – foods that are quicken broken down (fermented) by bacteria in the large intestine

Oligosaccharides – “oligo” means “few” and “saccharide” means sugar. These molecules are made up of individual sugars joined together in a chain. Beans are a common source of oligosaccharides.

Disaccharides – “di” means two sugar, so a disaccharide is composed of two sugar molecules bonded together. Sucrose is a disaccharide.

Monosaccharides – “mono” means single, so a monosaccharide is a single sugar molecule. Fructose is a monosaccharide.

And Polyols – these are sugar alcohols often used as sweeteners. Some examples are xylitol, maltitol, and erythritol

Background Information:

A low FODMAP diet refers to a temporary eating pattern, usually 7 to 10 days, that has a very low amount of FODMAPs. It is used in clinical medicine to relieve digestion-related symptoms such as gas, bloating, and irregularity in people dealing with IBS and other Functional Gastrointestinal Disorders (FGID).

Here is a list of some common foods and ingredients that are high in FODMAPs. Soto follow a low FODMAP diet, these foods are to be avoided:

A new study aimed to identify factors predictive of an efficacious response to a low-FODMAP diet in FGID patients with fructose or lactose intolerance. To determine whether patients had either fructose or lactose intolerance, breath tests were performed in FGID patients to determine intolerance (positive symptom score) and malabsorption (increased hydrogen or methane gas concentrations on the breath test). Once the patients with fructose or lactose intolerance were identified they consumed a low-FODMAP diet. A total of 81% of 584 patients completing the low-FODMAP diet achieved adequate symptom relief. These results were quite significant. Those with higher breath methane levels indicating fructose intolerance experienced the greatest degree of improvement in IBS symptoms. However, given the high overall response

Commentary:

This study provides some interesting insights. First, fructose could be a bigger issue for people than previously thought. Not only may it lead to a malabsorption issue causing looser stools it is thought to disrupt the microbiota or gut flora. My biggest comment on the study is that it may be more effective to support digestive function by using natural digestive aids rather than try to eliminate so many health promoting foods. Many of the foods excluded on the low-FODMAP produce beneficial effects on the intestinal microbiome – the collection of microbial genetic material in the gastrointestinal tract. A more rational approach may be to focus on supporting FODMAP absorption through the use of supplemental enzyme formulations rather than eliminating these foods.

It is well-established that taking lactase, the enzyme that helps breakdown lactose (milk sugar), can be very effective in helping those with lactose intolerance (about 75% of all adults worldwide). Fructose is a monosaccharide so malabsorption of fructose may indicate damage to the absorptive surface of the small intestine or lack of other digestive enzymes. When fructose is not absorbed in the small intestine, it is transported into the large intestine, where it is fermented by the colonic flora. That produces a lot of gas and causes a lot of symptoms such as bloating, diarrhea, flatulence, and gastrointestinal pain.

Here is my take on the situation, if fructose is not being absorbed it means that foods are not being properly digested and other nutrients are not being absorbed. The answer is not to go on such a restrictive diet, but to use digestive enzymes. A broad-spectrum enzyme formulation is probably the best way to go. I would opt for either Digest Gold or VeggieGest. Both of these formulas are made by Enzymedica and I am the Chief Science Officer of this company. Both formulas contain among many others the enzyme alpha galactosidase. This enzyme is the key in digesting the sugars and FODMAPs from beans, grains, raw vegetables and other foods.

Both Digest Gold and VeggieGest are produced via the Thera-Blend process. This process allows the mixture of digestive enzymes to be effective throughout the entire gastrointestinal tract. Most digestive enzymes are effective or active within a very narrow pH range and since the pH of the human gastrointestinal tract varies from very acid to alkaline, most enzyme supplements are not effective throughout the entire gastrointestinal tract. So, while an enzyme supplement may be helpful in one part of the digestive system, it may be totally inactive in another. Enzymedica’s Thera-Blend formulas overcome this problem by blending the best enzymes in a way that there is enzymatic activity throughout the pH range of our entire GI tract. Lab tests prove Enzymedica Thera-Blend enzymes are 3X Stronger and work more than 6X faster than leading other leading enzyme supplements. There is a reason Enzymedica is the #1 selling digestive enzyme brand.

The great thing about digestive symptoms like flatulence (gas), bloating, and regularity is that when a product or diet works it is usually quite obvious. To wrap this newsletter up, here is what I recommend:

Follow a low-FODMAP diet for 10 days supplemented with either Digest Gold or VeggieGest. This ten day period will help determine if FODMAPs are an issue in your digestive health complaints. If symptoms dramatically improve, then I would recommend to continue to keep FODMAP intake low, but not necessary totally avoided, we need those good foods. Just be sure to continue to use the digestive enzymes. You can then slowly increase the intake of FODMAPs to determine your intake threshold for producing symptoms. With the enzyme support, it should be significantly higher and they may not be an issue at all.

Welcome

On the Dr Oz show

On the show I discussed the failure of conventional medicine to address the underlying issues in many health conditions offering little more than drugs as biochemical “band aids.”

December is Seasonal Affective Disorder Awareness Month

In seasonal affective disorder (SAD) is associated with winter depression Typically, these individuals not only feel depressed they also feel tried, slow down, and generally oversleep, overeat, and crave carbohydrates in the winter. In the summer, these same patients feel very good and maybe even are elated, active, and energetic.

Although many variables may be responsible for SAD, insufficient light exposure is the most logical explanation. Many mammals exhibit seasonal variations in activity level, sleep patterns, and appetite and are extremely sensitive to changes in day length. The antidepressant effects of full-spectrum light therapy have been demonstrated in well-monitored, controlled studies in SAD. The antidepressant effect of light therapy is probably due to the restoration of proper melatonin synthesis and secretion by the pineal gland, leading to reestablishment of the proper circadian rhythm. Full-spectrum white light (10,000 lux) is prescribed for at least 30 minutes every day in the morning. Or, better yet, use full-spectrum lighting throughout the indoor environment.

The key hormonal change caused by exposure to full spectrum lighting may be a reduced secretion of melatonin from the pineal gland and an increased secretion of cortisol by the adrenal glands. Melatonin supplementation is thought to improve SAD because it increases brain melatonin levels, but it may also suppress cortisol secretion.Take 3-5 mg 45 minutes before retiring.

Vitamin D is also an important consideration. Many experts recommend a dosage of 2,000 to 5,000 IU of vitamin D3 daily, especially during the winter months.

Mind Your Ps and Qs

PQQ may be the perfect answer to preventing or reversing age-related mental decline.

kiwiPQQ (short for pyrroloquinoline quinone) is a vitamin-like compound found in plant foods that shows a wide range of benefits for brain function and energy production. Learn more about PQQ with the following Q&A.
What Exactly Does PQQ Do?

PQQ is an extremely potent antioxidant that is able to carry out the role of an antioxidant in the body more than 20,000 times—which is a rare thing. For example, other antioxidants, such as vitamin C, are only able to accomplish this “cycling” process about four times.
Are There Any Food Sources of PQQ?

PQQ has been found in all plant foods analyzed to date. Particularly PPQ-rich foods include parsley, green peppers, kiwi, papaya, and tofu. These foods contain 2–3 mcg of PQQ per 100 grams. Green tea provides about the same amount per 4-oz. serving. While these amounts appear to be sufficient in helping our cells carry out their basic functions, research indicates that boosting PQQ through supplementation can produce some amazing effects.